News Benzodiazepines Not Recommended For Patients With Ptsd Or Recent Trauma

[MyPTSD]

Benzodiazepine drugs are widely used in patients with posttraumatic stress disorder (PTSD), but available evidence suggests that they are not effective -- and may even be harmful, concludes a systematic review and meta-analysis.

Dead Link Removed

 

[anthony]

Interesting. In one breathe they say it worsens PTSD, yet the other it states that the indications for use of benzo's is those who have experienced trauma and using benzo's may lead to PTSD being diagnosed.

So which is it people? I read the information, and maybe I missed something, so please help me here.

What I read is that they're saying it can worsen PTSD, yet what I read only talks about those who have experienced trauma but not yet diagnosed with PTSD, and it can lead to PTSD and worsening.

So if you already have PTSD... where is the evidence that suggests they worsen things?

Given that just four randomized trials have been performed to date, the authors conclude that more studies are needed to conclude that benzodiazepines consistently worsen PTSD.

I hate how they include this type of information at the end, yet much earlier use big numbers like 5000 plus participants strong studies suggest this claim is accurate.

They started with 5k plus and 12 studies, ended with only 4 studies demonstrated this. Which four? What were the actual study numbers of those four to make such determination and headlines upon?

I have more questions than answers from this.

Is this a pharmaceutical conspiracy pushing a handful to try and pump up SSRI's again, knowing the evidence is clear on those... that they're all bad for PTSD and depression treatment. Have SSRI sales fallen that much because they suck, that they need try and wipe out the alternative that people are using because they actually work?

 

[Friday]

The 3 parts that really chafe me :

- Outweigh potential short term benefit... Um. Like not committing suicide?

- Why on *earth* use data from a non-socialized med country??? That's biased to begin with, as so many of us can't afford to go to the ER much less seek treatment later on, and the sample size is (always) horrifyingly small in American studies. Hundreds. Thousands. There are millions of data points available in socialized med countries to look for serious trends, longitudinally, even. Oh no. We'll use Americans? I loathe American studies. Size matters. Especially when looking for causation.

- Correlation is not causation :banghead:. Recent trauma + benzos = higher associated risk of PTSD? ... Seems to be missing some rather pertinent questions, and making some rather large leaps. I didn't see a good baseline for people who seek no treatment following trauma, nor the scale of severity of initial symptoms that prompted doctors to RX benzos to begin with, or who are only rx'd an initial sedative, or who use benzos as a safteynet long term (few times a year), and a few other meta analysis problems when overlaying data. Feels like polling how many people in the church on Sunday are Christians, or making the leap that autistic kids get vaccinations, therefore vaccinations cause autism... Without looking at the "everyone else" who also get vax'd. (Or brush teeth, or anything else.) What I was able to see was only reverse logic of tracing back people who are in treatment already for PTSD, if they had used benzos. But I couldn't actually look at most of the studies? Only dug out some of the Ohio stuff via the university / I don't have peer review access at the moment. Which studies were they using for their results??? Um. There are a few gaps, there.

 

[Friday]

I take it back... One more gripe. (And here I was coming back to apologize for being grumpy, and for posting before digging out more information, but FFS. They make it hard enough to verify what they're saying!)

" Dr. Guina and colleagues conclude that benzodiazepines are "relatively contraindicated" in trauma patients. They emphasize that there are now many different evidence-based treatments for PTSD -- including psychotherapy, antidepressants, and adrenergic inhibitors -- "all of which should be exhausted before benzodiazepines are considered." "

So... Something that takes 30 days to build up in a patients system, or months and months (or years) of extremely expensive therapy should be exhausted before a patient is given a shot in the ER? Before it's even considered??? Oh. So sorry you're suicidal. Go on home, with this Rx that will take effect in a month. Stiff upper lip, now!

Apparently still grumpy.

 

[anthony]

Go on home, with this Rx that will take effect in a month.

Worse yet, is that SSRI they're likely to prescribe you, has greater chance of making you more depressed than less depressed, based on massive study results obtained and meta analysed.

My last check on that subject was bordering near the 70% failure rate versus 30% success rate. The failure rate included, from memory, those who have severe reactions and required med changes, not just those who got much worse symptomatically.

 

[Weemie]

i'd think that benzos would help specifically after trauma because they can cause memories to be less associated? same with that beta blocker, isn't that what they figured a couple years ago? if the memories are less vivid, there's less chance for them to wire screwy. f*ck it, get the z-drugs. time to take apart the remote and eat it.

 

[falling_wave]

This is interesting. I have the same question as @anthony about what if it prescribed after ptsd diagnosis. It kind of makes sense if you surpress it immediately after a grauma it comes out in other ways or later on but if its already later on im not sure the same thing happens. The suppression of memory and cognitive areas of the brain are what caused the other recent study on benzos and alzheimers though. It would be awesome if it could target stress outside of those areas. SSRIs have always ultimately made my symptoms worse. One version made me feel better briegly and then much worse but mist of them worse the whole time. The month start date is pretty crazy too. Btw, what is adrenergic meds? I've never heard of that?

 

[Anarchy]

I loathe American studies.

American studies are correlated* with suicides... http://www.tylervigen.com/spurious-correlations

My last check on that subject was bordering near the 70% failure rate versus 30% success rate.

Which is a success rate that is almost, but not quite as big as the success rate for a placebo, and the placebo doesn't have side effects.

i'd think that benzos would help specifically after trauma because they can cause memories to be less associated? same with that beta blocker, isn't that what they figured a couple years ago? if the memories are less vivid, there's less chance for them to wire screwy. f*ck it, get the z-drugs. time to take apart the remote and eat it.

or hold up the local vetinary surgery for their stock of ketamine**, if the vet hasn't already used it for himself ;)
_____________________________
*spuriously correlated, but it is still an impressively strong spurious correlation
**it's used to euthanize cats and dogs, but in smaller doses, it has an effect similar to dissociation.

 

[scout86]

Just a quick correction, ketamine is used for "anesthesia" in veterinary medicine, not "euthanasia", although I suspect you could kill something with it if you wanted to. In this country, it seems to be most often described as "a horse tranquilizer". It can be used for that. From personal experience I can tell you it doesn't do an awesomely good job. There are WAY better drugs available for that sort of thing now. I think it IS still used some for short, small scale procedures and sometimes it's given to initiate general anesthesia. When you give it to cats, it's pretty common for the cat to behave like it's watching a bird flying around the room, or something similar, so it might be causing hallucinations.

 

[The Albatross]

I am currently on a low dose benzo (generic klonopin (spelling?). I had an entire class of meds ruled out systematically and this "trial" is only for a set duration of time (6 months). I seem to be tolerating it well though of course y'all know I'm also ADD/ADHD. This is long post traumas for me. But... my doctor is adamant that this a short term thing and I'm cool with that... so I'm really appreciating this discussion. My understanding (not much) is that this class of meds has something to do with GABA? Don't want to take this off track but... am interested in any commentary and am following along.

 

[anthony]

@The Albatross have you read the first link to benzo's here? That is fairly explanatory in simple terms about them. They have a proven track history to work effectively, yet also have a proven addiction history because they work effectively, and the way they work if the dose is high.

They do also have long-term harmful effects on organs and such, if taken in high doses for long periods of time. They're primarily effective for short duration / sporadic consumption and usage, as needed, say maybe a few times a week, or low dose if constant.

From memory, I believe the recommended max does for valium is 10mg no more than 3x daily. That is extremely high, and is near guaranteed to cause long-term damage if you took that amount for a long period of time, i.e. years.

Now if you took 5mg of valium daily, then your long-term effect can be minimised sufficiently to now much safer levels. This would lower the risk significantly, though not rule out entirely.

If you took 5mg here and there, say a panic attack you have once in a week, or you had two days where you felt really anxious and used 5 / 10mg for those two days only, then longevity effect is near non-existent now.

 

[The Albatross]

Thanks for the reply. Will do.